Calcium facilitates blood clotting and hypercalcemia causes faster clotting time to the point where they may occur when not needed. This can occur more easily vessels with slow blood flow.

Like many electrolyte imbalances that affect the heart (te most serios affect of hyperCa), initially it causews inc P and BP, but then prolonged Ca imbalance depresses electrical conduction slowing the heart.

Hypercalcemia (Ca2+): Treatment

> 10.5 mg/dL

Drug therapy involves preventing increases in calcium, as well as drugs to lower calcium levels.

Since 98% of K+ is ICF, increases in serum K+ reduce the difference between ICE and ECF concentrations of K+. This makes excitable membranes even more sensitive, even prone to spontaneous discharge. This is nowhere more important than the heart where high K+ values can cause dysrhythmias, which are the most severe problems from hyper-K and the most common cause of death. Ectopic (beats outside of normal conduction system) may occur.

Sudden rises can cause severe problems in the 6-7 range, whereas a slow rise may not cause problems until 8.

Hyperkalemia is rare in people with normal kidney function.

Neuromuscular changes of hyperkalemia?

> 5.0 mEq/L

tingling, burning and numbness of the hands and feet and around the mouth paresthesia

At mild rises in K+, muscle twitching and irregular contractions, but as condition worsens, muscle WEAKNESS, same as HYPO.

Respirator muscles are not affected until K+ reaches lethal levels.

Intestinal changes from hyperkalemia?

> 5.0 mEq/L

Increased motility. Sounds are hyperactive with rushes and gurgles over the splenic flexure and in LLQ. BMs are frequent and watery.

This is the same as Hyponatremia!!!!

Laboratory data to confirm hyperkalemia?

> 5.0 mEq/L

If caused by dehydration, levels of other electrolytes, hematocrit, and hemoglobin also are elevated.

27. An RN is assessing a 70-year-old client admitted to the unit with severe dehydration. Which finding requires immediate intervention by the nurse?

A) Client behavior that changes from anxious and restless to lethargic and confused

B) Deep furrows on the surface of the tongue

C) Poor skin turgor with tenting remaining for 2 minutes after the skin is pinched

D) Urine output of 950 mL for the past 24 hours

28. The nurse manager of a medical-surgical unit is completing assignments for the day shift staff. The client with which electrolyte laboratory value is assigned to the

LPN/LVN?

A) Calcium level of 9.5 mg/dL

B) Magnesium level of 4.1 mEq/L

C) Potassium level of 6.0 mEq/L

D) Sodium level of 120 mEq/L

29. A 90-year-old client with hypermagnesemia is seen in the emergency department (ED). The ED nurse prepares the client for admission to which inpatient unit?

A) Dialysis/Home Care

B) Geriatric/Rehabilitation

C) Medical-Surgical

D) Telemetry/Cardiac Step-Down

Because hypermagnesemia causes changes in the electrocardiogram that may result in cardiac arrest, the client should be admitted to the Telemetry/Cardiac Step-Down unit

30. A client with mild hypokalemia caused by diuretic use is discharged home. The home health nurse delegates which of these interventions to the home health aide?

A) Assessment of muscle tone and strength

B) Education about potassium-rich foods

C) Instruction on the proper use of drugs

D) Measurement of the client's urine output

31. A nurse is planning care for a client with Hypocalcemia. Which nursing action is appropriate to delegate to unlicensed assistive personnel (UAP)?

A) Collaborating with the dietitian to provide calcium-rich foods for the client

B) Evaluating the client's laboratory results

C) Implementing Seizure Precautions for the client

D) Transferring the client from the bed to a stretcher using a lift sheet

32. A client is admitted to the nursing unit with a diagnosis of hypokalemia. Which assessment does the nurse complete first?

A) Auscultating bowel sounds

B) Checking deep tendon reflexes (DTRs)

C) Determining the level of consciousness (LOC)

D) Obtaining a pulse oximetry reading

Because hypokalemia may cause respiratory insufficiency and respiratory arrest, the client's respiratory status should be assessed first

33. Situation: A 77-year-old woman is brought to the emergency department by her family after she has had diarrhea for 3 days. The family tells the nurse that she has not been eating or drinking well, but that she has been taking her diuretics for congestive heart failure (CHF). Laboratory results include a potassium level of 7.0 mEq/L. Which medication(s) does the nurse anticipate administering?

A) Insulin (regular insulin) and dextrose (D20W)

B) Loperamide (Imodium)

C) Sodium polystyrene sulfonate (Kayexalate)

D) Supplemental potassium

34. Situation: A 77-year-old woman is brought to the emergency department by her family after she has had diarrhea for 3 days. The family tells the nurse that she has not

been eating or drinking well, but that she has been taking her diuretics for congestive heart failure (CHF). Her laboratory results include a potassium level of 7.0 mEq/L.

What is the primary goal of drug therapy for this client?

A) Decreasing cardiac contractility and slowing the heart rate

B) Elevating serum potassium levels to a safe range

C) Maintaining proper diuresis and urine output

D) Restoring fluid balance by controlling the causes of dehydration

Drug therapy for dehydration is directed at restoring fluid balance and controlling the causes of dehydration.

35. Situation: A 68-year-old man is admitted to the hospital with dehydration. He has a history of atrial fibrillation, congestive heart failure (CHF), and hypertension. His current medications are digoxin (Lanoxin), chlorothiazide (Diuril), and oral potassium supplements. He tells the nurse that he has had flu-like symptoms for the past week

and has been unable to drink for the past 48 hours. The physician requests laboratory specimens to be drawn and an isotonic IV to be started. Which IV fluid does the nurse

administer?

A) 0.45% saline

B) 5% dextrose in 0.45% saline

C) 5% dextrose in Ringer's lactate

D) 5% dextrose in water (D5W)

36. Situation: A 68-year-old man is admitted to the hospital with dehydration. He has a history of atrial fibrillation, congestive heart failure (CHF), and hypertension. His current medications are digoxin (Lanoxin), chlorothiazide (Diuril), and potassium supplements. He tells a nurse that he has had flu-like symptoms for the past week and has

been unable to drink for the past 48 hours. The nurse starts the client's IV and receives laboratory results, which include a potassium level of 2.7 mEq/L. The physician

orders an IV potassium supplement. How does the nurse administer this medication?

A) Added to an IV, not to exceed 20 mEq/hr.

B) Added to an IV, not to exceed 30 mEq/hr.

C) Rapid IV push, a 25-mEq dose

D) Slow IV push, a 30-mEq dose

37. Situation: A 70-year-old female is admitted to the hospital with heart failure, shortness-of-breath (SOB), and 3+ pitting edema in her lower extremities. Her current

medications are furosemide (Lasix), digoxin (Lanoxin), and an angiotensin-converting enzyme (ACE) inhibitor (Lotensin). She states that she stopped taking her Lasix because

she did not think that it was helping her heart failure. Her physician orders furosemide (Lasix) 5 mg IV push. Which client assessment determines that the medication is

working?

A) Decreased blood pressure (BP)

B) Increased heart rate

C) Increased urine output

D) Weight gain

When giving Lasix, the nurse monitors the client for response to drug therapy, especially weight loss and increased urine output

38. Situation: A 70-year-old female is admitted to the hospital with heart failure, shortness-of-breath (SOB), and 3+ pitting edema in her lower extremities. Her medications are furosemide (Lasix), digoxin (Lanoxin), and an angiotensin-converting enzyme (ACE) inhibitor (Lotensin). She states that she stopped taking her Lasix because she did not

level is 2.5 mEq/L. Knowing all of the client's medications, what problem(s) does the nurse anticipate in this client?

A) Clinical manifestations of digoxin toxicity

B) Increased heart rate and blood pressure (BP)

C) Increased signs of congestive heart failure (CHF)

D) Signs and symptoms of hypernatremia

Hypokalemia increases the sensitivity of cardiac muscle to Lanoxin and may result in digoxin toxicity, even when the digoxin level is within the therapeutic range

39. Situation: A 77-year-old woman is brought to the emergency department by her family after she has had diarrhea for 3 days. The family tells a nurse that she has not been eating or drinking well, but that she has been taking her diuretics for congestive heart failure (CHF). She is receiving lactated Ringer's solution IV for rehydration. What

clinical manifestations does the nurse monitor during rehydration of the client? Select all that apply.

A) Blood serum glucose

B) Pulse rate and quality

C) Urinary output

D) Urine specific gravity levels

The two most important areas to monitor during rehydration are pulse rate and quality and urine output; however, decreasing specific gravity of urine is also an indication of rehydration

40. Situation: A 77-year-old woman is brought to the emergency department by her family after she has had diarrhea for 3 days. The family tells a nurse that she has not been eating or drinking well, but that she has been taking her diuretics for congestive heart failure (CHF). Her laboratory results include a potassium level of 7.0 mEq/L. What

does the nurse include in the client's medication teaching? Select all that apply.

A) Daily weights are a poor indicator of fluid loss or gain.

B) Diuretics can lead to fluid and electrolyte imbalances.

C) Diuretics increase fluid retention.

D) Laxatives can lead to fluid imbalance.

41. Situation: A 68-year-old man is admitted to the hospital with dehydration. Initial laboratory results include a potassium level of 2.7 mEq/L. He has a history of atrial fibrillation, congestive heart failure (CHF), and hypertension. His medications are digoxin (Lanoxin), chlorothiazide (Diuril), and potassium supplements. In time, he recovers from his dehydration and low potassium levels. He says to the nurse, "I would like to take fewer medications and eat foods that contain high amounts of potassium."